PID-Holistic Care in Tapila

In a Western setting, when a patient presents to the clinic with a condition that is likely communicable to members of their household, we have no means to ensure a follow up with the family members. In most remote villages of Papua New Guinea, I can usually ask my patients, or the village leaders to look for “so and so” and give instant treatment to the whole family! The ease at which I can do that makes me so happy! I love being able to provide holistic care for the whole family.

One of my hardest and most rewarding days on outreach occurred in the village of Tapila in the Western Province.

On our first day, I taught a physio class, I commonly refer to as ”How to care for your back and knees”. I had gathered all the ladies and told the hardworking men that they were welcomed to join. By the end of the teaching, I had a crowd of roughly 100 people, so I took the opportunity to broaden the teaching and asked what they would like to learn about, or discuss. The group was amazing, several key leaders asked questions. We covered Malaria, Nutrition, Water and Sanitation… and after a while I told the group that they could ask any questions they wanted. That if I didn’t have the answer, I would look it up, and answer them the following day. One lady took my offer; she came to see me after most people had gone and asked “How do I get rid of the pain associated with my Pelvic-Inflammatory Disease?”

I have got to love the “MEDSCAPE” App on my phone! I downloaded the whole medical database on my phone prior to go on outreach, it’s incredible the amount of resources available at our fingertip these days!

Pelvic-Inflammatory Disease or PID is something I had never heard of before. I looked it up in the village and when I realized that it was related to sexually transmitted infections (STI), I told the lady I would read up on it some more and come find her the next day.

I have never liked STI’s! I do have some very basic knowledge on them, but I can actually say that I have never really paid attention to anything ever said about them in nursing school or in medical technician training. I would literally do something else, and look away. I found them gross and had no desire to learn about them. Like an ostrich sticking her head in the sand…Little did I know, I would actually need to know about STI’s one day!

There was no avoiding it this time. I had told this lady I would answer any of her questions. So the quest for knowledge began. A few hours later, I knew:

-She would have had to have multiple/reoccurring STI to get PID
-In order to help decrease the symptoms, she needs to stop getting STI’s
-Symptoms worsen with each periods
-Hormonal contraception could decrease symptoms (by removing periods)
-If left untreated PID can lead to infertility.

The following day, I found this lady and had a good conversation with her. I found out that her husband had never been treated for any infections. So even if she had been properly treated for her STI’s, the fact that her husband had never been treated, would have resulted in reinfections… After all in all STI’s, both partners have to be treated.

Knowing that PNG has a very high rate of infidelity, I took the opportunity to discuss the topic with her. Although her husband did not publicly have a second wife, I could gather that she was in pain. She highly suspected that her husband was cheating and accepted it as the norm. We discussed the values of life, faithfulness and the importance of communication.

Hopelessness and powerlessness was on this lady’s mind as I inquired about infidelity. She din’t believe that it would ever stop. She was heart broken for her people. Coming from a different worldview, I didn’t understand how she couldn’t see hope. I talked about how a woman must accept to become the second wife in order for the husband to be unfaithful to his first wife. When presented with the idea that women could teach their daughters to refuse to be instrumental to wrecking families by becoming “the second wife”, life and hope flooded her face. Suddenly we spoke the same language. She was thinking of ways to educate young ladies, to mentor the next generation to honour marriage and faithfulness.

I then inquired about the possibility of her husband to get treated as well. She replied that in the past he hadn’t been interested to go to the health centre (feeling no symptoms himself), he had on one occasion accepted to take pills, but hadn’t completed the treatment. I suggested an interdisciplinary or family meeting. I asked the lady if she could ask her husband to come and meet with their community health care worker, myself and one PNG doctor who was volunteering with us. She had doubts that he would agree to come, but was willing to try. A few hours later, the couple was sitting outside the clinic. I let out a sigh of relief and gathered my team to meet with them.

I first welcomed them and thanked the husband for taking the time to meet with us, acknowledging the fact that he was a loving and caring men for his family. He didn’t seem too enthusiast to be at the clinic, but here he was and we had a chance to help this family. I clearly explained the extend of the condition of the wife. His face sobered up. I asked our PNG Doctor to explain them how one contracts STI’s. The man seemed concerned. I then talked about what I knew many places in PNG to be like, not blaming, but stating the obvious, and opening up to bring important information without accusation.

I often find in PNG, that mean could have many wives. When that is the case, all wives would need to get treated for STI’s otherwise, when the men sleeps with one wife that wasn’t treated, he contracts the STI again and reinfects his first wife.”

His face changed. I knew he understood. He accepted to receive full treatment (even the 2 injections), and held his wife’s hand as she received hers. He also agreed for his wife to receive an injection of Depo-Provera (hormonal contraceptive). He understood that she wouldn’t get pregnant. Offspring is really important in Papua New Guinean culture, but this man chose his wife’s health comfort over having a “numerous and respected family”. He chose health and life to the fullest. Once again, our Medical Ship’s motto rang true! “I Want to Live” / “Mi Laik Stap Laif”

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